Provider Demographics
NPI:1679614572
Name:BASDEN EYECARE
Entity type:Organization
Organization Name:BASDEN EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BASDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-887-6621
Mailing Address - Street 1:333 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-3814
Mailing Address - Country:US
Mailing Address - Phone:334-887-6621
Mailing Address - Fax:334-826-2059
Practice Address - Street 1:780 N DEAN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-4300
Practice Address - Country:US
Practice Address - Phone:334-887-6621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS765TA139152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529926610Medicaid
ALU44483Medicare UPIN